- Molina Healthcare (Tampa, FL)
- …**Job Summary** Establish a specifically designed compliance program that effectively prevents and/or detects violation of applicable laws and regulations, which will ... protect the Business from liability of fraudulent or abusive practices. Ensures that the Business understands and complies with applicable laws and regulations pertaining to the Health Care environment. Ensures the Business' accountability for compliance by… more
- CVS Health (Tallahassee, FL)
- …The ideal candidate will have deep expertise in CMS Part C and D programs, Medicare Advantage bid cycle management, and pricing strategies. This role requires a ... + Lead the development and execution of actuarial analytics strategies for Medicare Advantage and Part D programs. + Inform and enhance the end-to-end bid… more
- Humana (Tallahassee, FL)
- …internal teaching conferences, and other sources of expertise. Medical Directors will learn Medicare and Medicare Advantage requirements and will understand ... and genetics.** + Knowledge of the managed care industry including Medicare Advantage and Managed Medicaid. + Utilization management experience in a medical… more
- Humana (Palm Bay, FL)
- …Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to ... caring community and help us put health first** Are you passionate about the Medicare population, looking for an opportunity to work in sales, and wanting the… more
- BayCare Health System (Clearwater, FL)
- …of BayCare Health Plans and be responsible for prospecting and selling BayCarePlus Medicare Advantage plans to our Medicare community. + Responsibilities ... (AEP) season. **To Learn more about this area:** + BayCarePlus Medicare Advantage Plans (https://baycare.org/ medicare - advantage -plans) **Facility:**… more
- Elevance Health (Tampa, FL)
- …not limited to: + Analyzes and develops SAS and SQL programming to support Medicare Advantage risk adjustment initiatives. + Performs data mining and data-driven ... ** Medicare Risk Adjustment Advanced Analytics Analyst** **On-Site Requirement:...an accommodation is granted as required by law._ The ** Medicare Risk Adjustment Advanced Analytics Analyst** is responsible for… more
- Centene Corporation (Tallahassee, FL)
- …+ Identify prospective enrollees and determine eligibility for participation in the Advantage Medicare product + Understand and apply all policies and ... procedures pertaining to: + Disclosures and provisions of the Advantage Medicare product + Enrollment and disenrollment + Develop a presence in the local… more
- Humana (Tallahassee, FL)
- …productive. Our wholly owned affiliate, CarePlus, operates in 18 Florida counties, offering Medicare Advantage HMO plans that have been awarded 5-Star ratings by ... Vice President. **Key Responsibilities** + Initiate, negotiate, and execute value-based Medicare Advantage contracts and agreements with physicians and other… more
- Humana (Tallahassee, FL)
- …and allows you to see the overall end to end bid process at a leading Medicare Advantage organization. This is a great role for a collaborative individual who is ... may include monitoring and researching laws and regulations applicable to Medicare Advantage and actuarial science. Advises certifying actuaries, executives… more
- Humana (Tallahassee, FL)
- …internal teaching conferences, and other reference sources. Medical Directors will learn Medicare and Medicare Advantage requirements, and will understand ... **Preferred Qualifications** + Knowledge of the managed care industry including Medicare Advantage , Managed Medicaid and/or Commercial products, or other… more
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